title: Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection.
abstract: OBJECTIVE
  Is there a difference between women with endometriosis who underwent laparoscopic surgery with bowel resection or without bowel resection regarding depressive symptoms, relational adjustment and sexual functioning?
  
  
  CONCLUSIONS
  Radical surgery for endometriosis in both groups improved the levels of depression and sexual functioning, but only the bowel resection patients showed improvements in relationship satisfaction. WHAT IS KNOWN ALREADY?: The frequent pain symptoms in endometriosis patients can have an impact on psychological issues, relationships and sexual functioning. There are no data available on depression and relationship adjustment after endometriosis surgery. Sexual dysfunction problems have been described after bowel resection for rectal cancer, but no data are available for endometriosis surgery.
  
  
  METHODS
  This prospective cohort study included 203 consecutive women operated at the Leuven University Fertility Center (LUFC) between 1 September 2006 and 30 September 2008 for moderate (n = 67) or severe (n = 136) endometriosis. The preoperative response rate was respectively 84% in the bowel resection group and 79% in the no bowel resection group.
  
  
  METHODS
  The beck depression inventory (BDI) measured depression, the dyadic adjustment scale (DAS) measured relationship satisfaction and the short sexual functioning scale (SSFS) measured sexual functioning before and 6, 12 and 18 months after women had laparoscopic surgery at the LUFC, a tertiary referral centre for fertility exploration, treatment and surgery.
  
  
  RESULTS
  Both groups had better post-operative outcomes when compared with the preoperative assessments. Mean BDI and DAS levels were comparable with the normal population. Overall assessment points, the bowel resection patients had better outcomes for DAS (P < 0.05) and SSFS 'arousal' (P < 0.05) than the no bowel resection patients. At 6 months after the operation, when compared with the no bowel resection group, the bowel resection group reported lower mean levels of BDI (P < 0.05), a lower incidence of SSFS 'pain during intercourse' and 'orgasm problems' (P < 0.05), and a lower proportion of patients with severe orgasm problems (P < 0.05). The data show that radical but fertility sparing surgery, with or without bowel resection, for the treatment of endometriosis results in comparable and good psychological outcomes concerning depression levels, relationship satisfaction and sexual functioning.
  
  
  CONCLUSIONS
  Although the initial response rate was good, response dropped over time and was significantly higher for bowel resection patients compared with the no bowel resection patients (P = 0.05). A responder/non-responder analysis for the whole study population showed no significant differences concerning pain problems. This reduces the possible risk of (positive) bias in the results.
  
  
  CONCLUSIONS
  Endometriosis is a complex condition and the focus should not be on a one-dimensional end-organ gynaecological outcome, but should take into account the role of psychological factors in pain-related outcome. To this end, more prospective data are needed on sexual functioning and psychological outcomes.
authors.affiliation: Department of Gynaecology and Obstetrics, University Hospital Leuven, Campus Gasthuisberg, Leuven, Belgium. uschi.vandenbroeck@uzleuven.be
authors.forename: U
authors.initials: U
authors.lastname: Van den Broeck
authors.forename: C
authors.initials: C
authors.lastname: Meuleman
authors.forename: C
authors.initials: C
authors.lastname: Tomassetti
authors.forename: A
authors.initials: A
authors.lastname: D'Hoore
authors.forename: A
authors.initials: A
authors.lastname: Wolthuis
authors.forename: B
authors.initials: B
authors.lastname: Van Cleynenbreugel
authors.forename: I
authors.initials: I
authors.lastname: Vergote
authors.forename: P
authors.initials: P
authors.lastname: Enzlin
authors.forename: T
authors.initials: T
authors.lastname: D'Hooghe
mesh_terms: D000328:Adult; D001530:Belgium / Q000453:epidemiology; D015331:Cohort Studies; D003108:Colonic Diseases / Q000503:physiopathology / Q000601:surgery; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004715:Endometriosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007398:Interpersonal Relations; D007420:Intestine, Large / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008137:Longitudinal Studies; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012002:Rectal Diseases / Q000503:physiopathology / Q000601:surgery; D012720:Severity of Illness Index; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D062606:Tertiary Care Centers
keywords: bowel resection; depression; endometriosis; relationship satisfaction; sexual functioning